Community-Based Strategies to Increase COVID-19 Vaccine Acceptance Among Urban American Indian/Alaska Natives Living in Southern Arizona

Background

The COVID-19 pandemic has highlighted the severe health disparities and disproportionate burden of prevalence, hospitalizations and deaths in underserved communities of color (Webb Hooper, Nápoles, & Pérez-Stable (2020). Social determinants of disease, including the lack of access to health care and to culturally appropriate information, and historical mistrust contribute to these disparities (Thakur, Lovinsky-Desir, Bime, Wisnivesky & Celedón, 2020). The recent availability of COVID-19 vaccines requires effective strategies to enhance awareness and rapid dissemination of accurate and trustworthy information to ensure acceptance and equitable vaccination uptake in communities that are disproportionally affected by COVID-19. These strategies must also be community-based and culturally relevant to meet the needs of diverse populations. This paper will describe findings from a federally funded NIH community-based research study used to inform and enhance public health messaging about the COVID-19 vaccines for American Indian/Alaska Native people living in Southern Arizona.

Methods

A community-based participatory research approach was used to recruit and conduct focus groups to assess awareness, experiences, concerns, attitudes, needs, knowledge and misconceptions regarding COVID-19 testing, prevention, research participation, vaccination uptake, and medical mistrust among members of Southern Arizona’s urban American Indian/Alaska Native communities. Purposive sampling was used to recruit participants with input from community-based partner organizations and facilitated by staff who are culturally appropriate for the target audience. Focus groups were held on Zoom to ensure the safety for participants and facilitators. Transcripts from audio files were uploaded onto the Dedoose software and analyzed using a thematic analysis to assess the prevailing patterns, commonalities, and differences within and between focus groups.

Findings

Focus group participant data (n=60) were analyzed and concerns about COVID-19 vaccines included a distrust of the COVID-19 vaccines, and more largely, a distrust of western science due to the past and current traumas American Indian/Alaska Native people have endured (e.g., genocide via deliberate infection of measles/smallpox). Participants also described simultaneously wanting to trust western science due to the urgency of the pandemic. Participants identified a need for increased transparency and visibility among American Indian/Alaska Native political leaders, traditional healers, physicians, and community members to share their experiences of why uptake of the vaccine is necessary for overall community health and protection. Participants also described where role model stories could be disseminated which included: tribal website homepages, tribal/community Facebook pages, as well as on trusted organizational websites that serve the community.

Conclusions/Implications

This paper explores perceptions and strategies related to COVID-19 vaccines and their acceptance and equitable uptake among urban American Indian/Alaska Native people living in Southern Arizona. Findings included a distrust of COVID-19 vaccines as a result of historical and current traumas. Participants identified a need for more transparency and visibility via the use of American Indian/Alaska Native role model stories to illustrate the experiences of those who received the vaccine. Ultimately this information is significant for enhancing public health messaging efforts to increase vaccine acceptance and uptake.